[Show abstract][Hide abstract] ABSTRACT: Pulmonary vein isolation (PVI) is an established treatment option for paroxysmal atrial fibrillation. Recently, a novel endoscopic ablation system (EAS) was introduced. The incidence and severity of ablation-induced esophageal thermal lesions (ETLs) are unknown.
The purpose of this study was to investigate the incidence and severity of ablation-induced ETLs.
This prospective analysis compared two groups: group A underwent EAS-based PVI, and group B received PVI using radio frequency current (RFC). If esophageal temperature measured via an endoluminal temperature probe exceeded 38.5°C, energy application was stopped immediately. Endoscopy was performed 2 days postablation.
Forty patients (20 female, mean age 56 ± 10 years) were treated with the EAS system (group A). In 20 patients (seven female, mean age 63 ± 9 years) RFC-based PVI was performed (group B). Esophageal endoscopy was performed 2.1 ± 0.8 (group A) and 2.8 ± 1.2 days postablation (group B), respectively. In 7/40 patients (18%) in group A, thermal lesions (four thermal ulcerations, three minimal thermal lesions) were detected. In group B, 3/20 patients (15%) displayed thermal lesions (three minimal thermal lesions). All thermal lesions resolved upon repeat endoscopy performed 8 ± 6 (group A) and 5 ± 1 days (group B) after initial endoscopy.
In the EAS group, ETLs were found in 18% of patients, as compared with in 15% in the RFC group. In patients with ETLs, ulcerations were found in 57% in the EAS group, as compared with 0% in the RFC group. This may indicate that the quality of thermal lesions is more severe in the EAS group. Further investigation is required.
No preview · Article · Jun 2011 · Heart rhythm: the official journal of the Heart Rhythm Society
[Show abstract][Hide abstract] ABSTRACT: Pulmonary vein isolation (PVI) is an established treatment option for atrial fibrillation (AF). Recently the novel endoscopic ablation system (EAS) was introduced and proved potential for successful acute PVI.
This study sought to investigate the 1-year follow-up results after EAS-based PVI.
A total of 40 patients (20 female, age 57 ± 9 years) with a long history (5 ± 4 years) of drug-refractory (2 ± 1 antiarrhythmic drugs) paroxysmal AF were included into our analysis. PVI was performed using exclusively the novel EAS. Follow-up included regular telephonic interviews, Holter electrocardiographic (ECG) and transtelephonic ECG recordings. A symptomatic or documented AF episode >60 seconds after a blanking period of 3 months was defined as recurrence.
A total of 155 PVs were targeted; 153 of 155 (99%) PVs were isolated successfully using exclusively the novel EAS. During a median follow-up of 402 (331 to 478; quartile 1 to quartile 3) days, 24 of 40 patients (60%) remained free of any symptomatic or documented AF episode without antiarrhythmic drugs after a single procedure. Seven patients suffering from AF recurrence underwent radiofrequency current-based Re-PVI 203 ± 102 days after the index EAS-based procedure. Left atrium to pulmonary vein reconduction was found in 17 of 25 initially isolated PVs. No PV stenosis was detected based on magnetic resonance imaging 3 months postablation.
Patients after EAS-based PVI due to paroxysmal AF demonstrate 1-year single-procedure success rates similar to those of other ablation techniques and ablation energies. The major determinant for AF recurrence after EAS treatment seems to be reconnection of previously isolated PVs. More patients and longer follow-up periods are mandatory before final conclusions can be drawn regarding the efficacy and safety of the EAS.
Full-text · Article · Feb 2011 · Heart rhythm: the official journal of the Heart Rhythm Society
[Show abstract][Hide abstract] ABSTRACT: Pulmonary vein isolation (PVI) is increasingly performed to treat atrial fibrillation and can be achieved by continuous circular linear lesions around the pulmonary veins using radiofrequency ablation. Due to the technical complexity of this procedure balloon-based devices have been developed to simplify PVI. Cryoballoon ablation provides excellent safety and is technically less demanding when compared to radiofrequency catheter ablation in selected patients. In this review, advantages as well as drawbacks of this emerging technology in relation to standard catheter ablation are discussed.
No preview · Article · Jan 2010 · Journal fur Kardiologie
[Show abstract][Hide abstract] ABSTRACT: Kurzfassung: Die vollständige elektrische Iso- lation der Pulmonalvenen vom Vorhofmyokard mittels Katheterablation wird mit weltweit zu- nehmender Häufigkeit zur Behandlung von Vor- hofflimmern eingesetzt. Die vorherrschende Ablationsstrategie besteht in der Anlage zirkum- ferenzieller Läsionen um die rechten und linken Pulmonalvenenostien unter Verwendung von Hochfrequenzstrom. Aufgrund der hohen techni- schen Ansprüche, welche diese Prozedur an den interventionellen Rhythmologen stellt, wurde mit der Kryoballon-Technologie ein Verfahren entwickelt, welches die Pulmonalvenenisolation mit einer oder wenigen Energie-Applikationen ermöglicht. Vor- und Nachteile dieser relativ jun- gen Technologie werden in dieser Übersicht im Vergleich zum Standardverfahren dargestellt. Abstract: Cryoballoon Pulmonary Vein Iso- lation for the Treatment of Paroxysmal Atrial Fibrillation. Pulmonary vein isolation (PVI) is increasingly performed to treat atrial fi-